The Difficulties of Female Entrepreneurs in the UAE

The Difficulties of Female Entrepreneurs in the UAE Overview Introduction Entrepreneurs, regardless of their inherent location or gender, share similar problems in relation to properly accessing sufficient capital to start their business, developing a sufficient cash flow to sustain their venture and a variety of other distinctions that are connected to the process of developing a business.Advertising We will write a custom essay sample on The Difficulties of Female Entrepreneurs in the UAE specifically for you for only $16.05 $11/page Learn More With the development of new internal policies within the UAE comes an era where women have become more empowered, both in the workforce and in entrepreneurship. This is evidenced by the fact that nearly 54% of all university graduates within the UAE are women and that a growing percentage of them focus on furthering their own careers and the development of their family business or their own business [1]. This is not to imply that women themselves cannot be entreprene urs within the country, far from it: women are actually actively encouraged to take part in business and several have become successful entrepreneurs. However, there is some empirical evidence indicating that women are not actively involved in entrepreneurial activities. For instance, one can speak about a low rate of female entrepreneurship since only 3 out of 10 businesses started by women [2], [3]. It is possible to examine the situation in other countries, for example, one can mention that in Russia, 44 percent of entrepreneurs are represented by women [4]. Overall, the increasing number of female entrepreneurs is a trend that has been observed over the last two decades, following the collapse of the Soviet Union. Similarly, it is possible mention such a country as Thailand where the populations of male and female entrepreneurs are relatively equal [5]. This tendency has been prevalent since 2002 [5]. To some extent, this phenomenon can be explained by the growing economic devel opment of this country and the absence of legal barriers to entrepreneurship. Thus, the level of female entrepreneurship in the UAE is lower in comparison with other states. Therefore, it is possible to conjecture that there are some barriers that prevent women for pursuing entrepreneurial career. These restrictions come in the form of: women needing permission from a male to start a business insufficient support from the government, lack of collaboration with other women.Advertising Looking for essay on gender studies? Let's see if we can help you! Get your first paper with 15% OFF Learn More In this research what will be analyzed are the inherent difficulties experienced by female entrepreneurs within the UAE from 10 year back to now. It is expected that through the various facts and arguments presented in this research, a clearer picture can be developed regarding what difficulties female entrepreneurs experience within the UAE and what processes have been put in place by the government in order to address such issues. It is expected that through proper investigation and analysis, this research will create effective suggestions as to how female entrepreneurs within the region can best respond to the financial opportunities and challenges they are currently experiencing. Problem Definition Ten years ago, female entrepreneurs within the UAE suffered from a string of limiting factors that prevented their expansive growth. This came in the form of traditional cultural practices, insufficient government support and lack of proper access to financial institutions [6]. Since these factors were in place ten years ago, this research will thus seek to determine whether these problems continue to exist at the present, how female entrepreneurs view such problems and what solutions may be needed in order to effectively address them. It is based on this discovery that in the following section an investigation will be conducted regarding the curren t perception of female entrepreneurs involving the problems they face and what possible means of addressing them could be developed. It is possible to hypnotize that the current policy system within the region suffers from significant gender specific biases. This creates barriers towards the creation of a better business environment for female entrepreneurs. What is necessary is the development of better policy initiatives in not only removing gender barriers in entrepreneurial activity but also in developing the necessary networks for female entrepreneurs to thrive. Another necessary examination is to elaborate on the current status of female entrepreneurial funding within the country and how this has affected the success/ failure rates of entrepreneurs. Another question that must be explored into is whether all the recent programs aimed at creating better conditions for female entrepreneurs have been effective or have things remained the same despite their implementation? The end result of such an analysis is to understand what methods of funding can contribute to the development of female entrepreneurial activities.Advertising We will write a custom essay sample on The Difficulties of Female Entrepreneurs in the UAE specifically for you for only $16.05 $11/page Learn More The question of the research is: What are the key obstacles that women entrepreneurs in the UAE believe they faced 10 years ago, and what has changed, for better or worse ?, Women entrepreneurs in the UAE face a lot of challenges [3]. Studies indicate that despite the rapid growth of women entrepreneurs in both developed and developing countries as the UAE. The issue of gender equality, particularly within the UAE cultural context, stands not efficiently resolved [7], [8], [9]. Entrepreneurship plays a significant role in boosting economic growth. The UAE happens to be among the country that shows impressive progress in economic growth, through encouraging entrepr eneurship projects. Most of the women entrepreneurs in the United Arab Emirates participate in small-scale businesses, and hence receive socially little support [10]. However, women in the UAE go through lots of challenges running their own businesses [8], [9]. There are several factors against women entrepreneurship in this region. These include cultural factors, religion restriction, opportunity recognition, work-family balance, motivation, gender discrimination, financial support, and performance among others [11]. Recognizing opportunities is a bit hard for the Emirates women, considering that gender differences are linked to the varying variables of human capital. The differences primarily revolve around work experiences and education. In the UAE, men receive more advantages than women, considering that their experience in entrepreneurship and management of employees is a bit higher. Researchers indicate that women have less human capital to invest in businesses compared to men [10], [9], [10]. This makes it hard for women to identify opportunities and utilize their potential skills, experience, and power. The restricted structure in labor markets of the UAE, demotivate women entrepreneurs on grounds of gender inequality. The cultural and religious factors to some extend play a significant role in denying women right to own businesses without the support of their male partners.Advertising Looking for essay on gender studies? Let's see if we can help you! Get your first paper with 15% OFF Learn More On the contrary, the womens entrepreneurship experience in other countries such as Jordan and Kuwait is quite different. This trend can be partly explained by the educational differences between the countries. For instance, in Kuwait, female graduates outnumber male graduates by more than 20 percent [12].. However, the same thing cannot be said about the UAE. The recognition of womens entrepreneurship’s contribution to economic growth is higher in these Arab countries compared to that of UAE. For instance, the Kuwait Economic Society implements projects that empower women. These projects enhance trade and investment [13], [14], [15]. They also focus on creating a business environment that supports women entrepreneurship. For instance, an already established KES program in Kuwait provides women with opportunities such as training, sharing of experience, business networking, and growth among others. In Jordan, there are numerous funded projects that create awareness of issues s urrounding business environments. Here, women receive training concerning entrepreneur issues such as performance and decision making processes [15]. This promotes their entrepreneur projects. Jordan and Kuwait also strengthen legal awareness of issues surrounding women entrepreneurs. This increases the depth of their skills, techniques and offer capital to women for starting new businesses. This all in the long run contributes a lot to the economic growth of the country [14]. For instance, Saudi Arabia offers them 3,000 Saudi Riyals every month to start new businesses [15]. To a great extent, this strategy has been effective since it contributed to increasing the percentage of entrepreneurs from 14. 8 to 26 during the period between 2009 and 2011 [16]. There are several measures that should be put in place to help women entrepreneurs in UAE to overcome challenges in businesses. These include education, training, and support of the UAE governmental funds among others [15]. The UAE s hould copy some practices from countries like Kuwait, Jordan KSA, and other developed Arab countries, which encourage women entrepreneurship [16], [17]. These countries understand the importance of women entrepreneurs in economic growth, and employs strategies that influence them to become entrepreneurs. However it is clear that the UAE has made a progress in addressing issues associated with the Emirati women. For instance, the Mohammed bin Rashid Al-Maktoum Foundation in collaboration with the American University of Beirut came up with a plan supporting women innovation and entrepreneurship in 2008. New programs have also been introduced in the country enabling the emergence of many partnerships of women entrepreneurs and large corporations. In 2009, the chamber of commerce and industry registered more than 4,160 women as members [18]. Motivation and Relevance to Masdar/UAE Since Masdar City is a clean, green and sustainable city, this atmosphere requires innovational yet responsi ble business ideas. The UAE Women entrepreneurs could try translating, their creative business ideas to sustainable technologies, producing useful products, providing environmentally friendly services or maybe help with creating new jobs in Masdar. Objectives The primary objective of this paper is to compare the situation of female entrepreneurs within the UAE 10 years ago with their current situation in 2013. Through this analysis, this research will be able to show whether sufficiently positive developments have been enacted that would be conducive towards developing a better environment to encourage female entrepreneurship within the UAE or not. In this research what will be examined is the current state of SME’s within the UAE and the situation of female entrepreneurs in 2014 as compared to how they were ten years ago. This paper will be able to determine whether sufficiently positive changes have been implemented resulting in a better overall situation for the growth of female entrepreneurship within the UAE. Through this section, a greater understanding will be developed regarding the various factors that restricted the growth of female entrepreneurship within the region and if such factors continue to take a dominating role in gender based entrepreneurial growth. So far, what this section has shown is that the problems female entrepreneurs currently face within the country come in the form of traditional cultural practices, insufficient government support and lack of proper access to financial institutions. When comparing the data from the article â€Å"Small Enterprises: Women Entrepreneurs in the UAE† by Hans Christian Haan with current academic articles examining the state of female entrepreneurship within the country, it was shown that the issues have remained roughly unchanged from the time that the Haan article was written. It is based on this that the primary objective of this paper is to expound on such issues and determine how the y can be resolved. In conclusion the main objective of this research would be to attempt a 10-year review of Haan’s study results to see whether the same conclusions apply today – after many innovational attempts nationwide were formed or not. What factors faced women in the past get improved, and which still stand and needs further investigation, action or regulation. Some ways to inspire and assist woman entrepreneurs in the UAE would be: Empowering UAE’s woman entrepreneurs to seek collaborations with educational and research institutes that promote development of novel innovative and practical business ideas. Educating enterprising entrepreneurs on development and creation of creative innovations that have high chances of legalization, with potentially big impacts on the economy where ready market is available. Empowering woman entrepreneurs with knowledge of identifying the processes and procedures those innovative ideas must pass through in order to be so cially accepted as viable and worth investing in. Educating entrepreneurs on ways of getting government funding and reaching out to non-governmental organizations to fund their innovations and noble ideas; entrepreneurs fail to venture into markets due to inadequacy or complete lack of funds and under-informed on available sources of funds. Literature Review Entrepreneurship Development in the UAE The main measures of entrepreneurship skills are scores on motivation, personal attitude and aptitude. Action planning in entrepreneurship is of importance to create solution oriented task and strategy implementation function for quantifying task orientation levels [30], [31], [32]. Thus, a budding entrepreneur must possess task orientation leadership skills at an individual task management level in reviewing actual and expected outcome of any business opportunity [33], [34], [35]. With the number of entrepreneurs supplying or dealing with similar products and services on the rise, it is imperative for entrepreneurs or businesspersons in UAE to understand factors influencing the consumer purchase decision in order to design the best strategy for meeting consumer demands [32], [37] [36]. Scholars in the field of economics have approached entrepreneurship from different perspectives with numerous views regarding entrepreneurships and innovation. Peter suggests that entrepreneurship goes in hand with innovation, changes and opportunities for innovation [38]. On the other hand, Steve Blank, a business school professor avers that entrepreneurship is about getting out into the world and doing and not basically researching and writing [24]. These scholars do agree that entrepreneurs face difficulties of finding the right opportunities and the needed innovation, creating competitive brands using strong products and finding the right markets [39]. Rob and Marry postulate that innovation involves doing things differently or doing different thing in order to arrive at large ga ins in performance at micro and macro level of entrepreneurship [36], [37], [38]. The two authors further recognize that lack of capital and funding is the main obstacle for innovation. Others however contrast with Rob and Marry by associating innovations with the rise of technical inventions such as the computers and steam engines [10], [34]. As opined by Schawbel [35], [36], [37] an excellent entrepreneur should possess transformational leadership skills that identify a range of problematic situations that an individual faces in his or her social environment, and generates multiple alternative solutions to those problems. Besides, he/she should lay a series of procedures that are necessary to achieve desired results rather than postponing response strategies [38], [39]. The three building blocks of situational management skills include learning intra personal performance, supportive learning environment, concrete learning processes, and practice leadership that reinforces performa nce [40], [41], [42], [43]. Entrepreneurs in the developed countries (USA, Sweden and Finland) Although government policies, infrastructure and large markets provide vast investment opportunities in developed countries, young entrepreneurs continue to face challenges [8]. [15] Point out that the decline in economic growth has resulted in decline in entrepreneurship opportunities and constant increase in business’ start-up costs. Young entrepreneur’s sale their ideas to capital ventures and find themselves exploited as capital ventures benefit and leave them with nothing [19]. Other scholars argue that the content of entrepreneurship in the local education especially in Finland is so wide; the methods of teaching entrepreneurship in schools are poor and the goals of the entrepreneurial education conflict with the local business environment [7], [18], [19]. According to MoniaLougui, young entrepreneurs in Sweden and in the developed countries face entry barriers; these a re obstacles that promote existing firms to make constructive economic proceeds while making it difficult for new firms to make impacts in the market. They also face financial barriers and cultural and value barriers [17], [20], [21]. Challenges Facing Swedish Entrepreneurs Rojewski [34] shows that entrepreneurship and small firms play a significant role in economic growth. Entrepreneurship is considered as innovation. It drives people to create their own jobs, and hence improves their living standards [11]. The author identifies the obstacles that entrepreneurs go through, when starting businesses. Most of the Swedish entrepreneurs, particularly the women, find impediments and challenges when starting businesses [21]. Through the use of a multinomial regression, the author confirms that administrative costs and financial problems are the primary barriers to success of new businesses in Sweden [29]. In addition, the self-employed individuals who invest in manufacturing industries fa ce many obstacles during the early stages of product development. In relation to the Emirates women entrepreneurs, it can be confirmed that women entrepreneurs in most parts of the world, particularly those in the developing world face lots of problems when starting their businesses. Considering that the link between entrepreneurship and economic growth is positive, countries all over the world should modulate entrepreneurship. The UAE, for instance, needs to call off the cultural and religious barriers that restrict women from starting their own businesses. Economic growth enhances high living standards, and hence improves the lives of women who would have otherwise been left to depend on their husband for everything [30]. Entrepreneurs in Gulf Countries The Gulf region has attracted a lot of attention in the recent past due to its rapidly growing economy, especially Abu Dhabi and Dubai. Researchers suggest that the main obstacles facing young entrepreneurs in the Arab world is hav ing access to capital [21], [22], [23]. To a great extent, this opinion is shared by women who were surveyed during my study. Saifur Rahman [24] further says that despite Small and medium enterprises (SMEs) contributing greater percentages in national GDP, they are highly neglected and Lending for SMEs in the Gulf Coast Countries is very low and access to finance is the Greatest Challenge. Khalid Al Ameri argues that that the Middle East education system has not shifted to meet the needs of the current technology and young entrepreneurs may not have enough knowledge about the business environment [23], [25]. HanifaItani, Yusuf M. Sidani and ImadBaalbaki [17] support Khalid Al Ameri saying that insufficient managerial and financial information and lack of government support are major obstacles to UAE SMEs and entrepreneurs. Bruhn et al point out that lack of managerial capital is the key restriction for young entrepreneurs in most developing countries [26], [27], [28]. Consumer Behav ior in UAE and Entrepreneurship Development Consumers in UAE exhibit a particular sequence of purchases or proportion of purchases that may be predictive of consumer behaviors such a brand loyalty due to their unique Islamic culture. Consumer behavior can be determined through listening carefully to what the customers say about a product or service. The focus here is to consumers feeling through assessment of her voice and comments about a product or service [44]. Understanding of consumer behavior facilitates effective entrepreneurship and promotion resources through ensuring that such activities are well planned in order to yield the desired result in the most efficient and effective way possible [45], [46], [47]. Consumer behavior in UAE is not only of great importance to entrepreneurs but also crucial to consumer protection agencies, ethicists, public policy makers and regulators and consumer advocacy groups who protect consumers from any unsafe offerings or decisions by markete rs [46]. Understanding consumer behavior in UAE enables entrepreneurs to strategize on the best way to reach out to the clients. It also assists in establishing ways of changing unfavorable consumer behaviors as well as reinforcing positive behavior patterns [48], [49]. Factors Undermining Entrepreneurship Development in UAE The detrimental of insourcing to entrepreneurship attitude in UAE is often negative. The outsourcing UAE government has lost considerable taxes when only the foreign entrepreneurs carry out insourcing services. The outsourcing government cannot claim revenue on taxation because this benefit ends up with the foreign country that insources [51]. In addition, there is great concern regarding the rate of unemployment of local countries that outsourcing some activities to the insourcing countries. The situation became even more critical when developed countries compose the insourcing team as is the case in UAE. As a result, the rate of entrepreneurship development in UAE has been slow [51]. UAE has a reputation of setting high legal expectations of a business which is a repellent to internal and external entrepreneurship investors. Federal law of 1975 no. 5 on commercial registration makes verification of a business difficult since it has to pass many a lot before approval [4], [5]. Federal law drafted in 1992, no. 37 defines the provision of patent and trademark rights in UAE has helped eliminate the chances of fraudulent attempts on a company’s product to ensure that the company is not disadvantaged. Besides, federal law no. 13 drafted in 2007 defines the legality of import and export business to ensure that entrepreneurs are protected [4], [5]. We could take up this as an assurance of the protection to be offered to their products against illegal dealers though the registration process is very expensive in time and cost. For the social dimension of the evaluation of the UAE market for entrepreneurship products, it is necessary to tail or such products to suit the acceptable cultural norms. This way, it is necessary for the entrepreneurs who are carrying out the research to evaluate the literacy levels of the UAE people. Specifically, it is recorded in the World Fact book of the CIA that literacy level by 2003 was at an average of 97% among young generation who are the target of entrepreneurship activities. [50], [51], [52]. This will include the evaluation of the education system and levels. Most importantly is to link the findings to the target market of entrepreneurship products. By doing this, entrepreneurs in UAE will establish the level of awareness of the people of UAE. Several questions may pop up during this feasibility study. Comprehensively, it would be necessary to establish how conversant the people of UAE are to technological advancements constantly changing a cross the global arena [53], [54], 55]. The answers to this question could be relative as it depends on the country’s technological adv ancement. Research has it that UAE though very populous, have a high percentage of the literate in its population [56]. UAE has a high number of literate young who would be the target consumers for entrepreneurship products [57]. This is as a viable business opportunity. Women Entrepreneurs in the UAE Haan [58] gives a clear explanation concerning the UAE women entrepreneurs, their experiences in the field, and the roles played by public and private agencies in modulating entrepreneurship [59]. The author provides an analysis and a survey of 30 UAE women entrepreneurs. The survey involves in-depth interviews concerning how they run their businesses, the challenges they face, and the support they get to pursue or continue running their enterprises. The Haan’s article provides a study about two different segments namely, the modern and traditional activities in the UAE women-managed enterprises. The latter is engaged in the most recent economic activities. In incorporates advan ced information and communication technologies and updated practices of businesses [60]. It is in most cases run by young UAE women, educated and business-oriented [57]. On the other hand, the traditional activities segment consists of simple manufacturing and trading [56]. The study in Haan’s article analyses the constraints faced by the UAE women entrepreneurs, and gives suggestions for the most appropriate recommendations. For instance, there is a need to formulate policies and create institutional capacity that promotes women entrepreneurship. There is also a need for pursuing specific support services for segments, as well as the government support and other agencies in the UAE [51]. Entrepreneurship, Emirati perspective [26], [55] narrate that globalization, technological advances, and innovations among others are instrumental in the transformation of societies in the world [32]. However, there are challenges and opportunities associated with the aforementioned shifts p articularly in women entrepreneurship. According to the authors, for the UAE to become a fully transformed entrepreneurial nation, it has to inculcate entrepreneurship at an early stage. This should include teaching children at their early age about it, incorporating it in the education system, and using awareness platforms to inform, educate and influence people, particularly women, on the need to pursue entrepreneurship [33]. There is also a need to formulate policy insights to give policy makers a direction to assist them formulate efficient policies and programs to support the UAE women entrepreneurs. As mentioned earlier, the UAE has shown an impressive progress in the recent past with regards to social development and economic growth sustainability [38]. For instance, in 2011, the GEM study survey in 54 economies confirmed the UAE as one of the most innovation-driven country in the world. However, the nation needs to continue making immense progress in strengthening entreprene urship, particularly women entrepreneurship [39]. This will not only help them become creative and create new jobs, but also enable them to empower others to do the same. This will ensure that the future generations of the UAE will be vibrant both in entrepreneurship and in growing the country’s economy [40]. Women business owners in the UAE In the article â€Å"Women business owners in the United Arab Emirates† it is clear that the UAE women entrepreneurs are more educated than those from Jordan, Tunisia, and Kuwait among other countries [37]. According to the survey conducted in UAE, more than 89% of women entrepreneurs have an optimistic outlook towards their businesses and the country’s economy at large [38] [39], [40]. More than 73% of the women surveyed focused on growth and expansion, but needed financial opportunities. Only 8% felt that running a business was disadvantageous for them. This confirms that most of them love managing their own businesses com pared to those from other Arab nations [39]. Female business students in the Middle East Hossan, Parakandi, and Saber suggest that there are several barriers that restrict female students in the Middle East from pursuing entrepreneurship interests [23]. The authors analyze the strengths/opportunities, weaknesses/issues and challenges that these students get exposed to in the country. From their research, it is evident that despite having potential to start ventures, these students lack enough knowledge about the organizations that support ventures [68]. Prior work experience and different entrepreneurship barriers, which are based on gender discrimination, deny women opportunities to participate in business ventures [23]. Current Attitudes Regarding Business Financing Based on the article â€Å"Small Enterprises: Women Entrepreneurs in the UAE† by Hans Christian Haan, it was noted that women within the UAE rely on their own personal savings as their primary method of creating startup capital [4]. This is an incredibly laborious and time consuming process which would of course slow down the process of entrepreneurial activity within any country that utilizes such a system [5]. Such a situation is in stark contrast to the way in which the entrepreneurial sector in other countries such as China, the U.S., the UK and even in certain sectors in the Middle East work since it is often seen that investing in entrepreneurs creates numerous beneficial actions, such as a better local economy, greater amount of bank deposits and helping out what could potentially develop into a larger enterprise [13]. As a rule, financial institutions are very cautious when deciding whether to invest in a start-up enterprise. In many cases, they need to see guarantees showing that the loan can be repaid. Therefore, in many cases, entrepreneurs find it challenging to accumulate capital. After conducting an analysis of the Erogul article which examined the current situation of women entrepreneurs within the UAE, it was revealed that female entrepreneurs still continue to rely on their own slowly accumulated capital as compared to merely taking out a bank loan [3]. This shows that from 2004 till the present, there has been little change in the cultural attitude regarding entrepreneurial financing among women [8]. One of the potential reasons behind such a state of affairs has been connected to the currently arduous process of taking out a loan within a bank wherein a male sponsor is needed in order to sign and guarantee all aspects of the loan [13]. Since female entrepreneurs have to rely on a sponsor who may not always be there, this further impedes the process of business development which actually discourages women from relying on banks as a source of capital 10]. It was seen that in the article â€Å"Small Enterprises: Women Entrepreneurs in the UAE† by Hans Christian Haan that in the case of the UAE, family played a crucial role in the funding and de velopment of small to medium scale business ventures for women wherein more than 25% of local businesses started by female entrepreneurs were a result of family members contributing towards the initial starting capital of the entrepreneur and actively gave advice regarding the proper management of the business [10]. In fact, it was noted by researchers such as Mostafa (2005) that it is the strong interfamily ties within the countrys culture that limits the export market of the UAE. This is due to the development of a business culture where it has become preferable to deal with family members or friends of the family when it comes to joint business ventures and business opportunities. This in effect severely curtails the ability of a business to expand beyond its current market due to the inherent hesitance in dealing with the unfamiliar [5]. While there is nothing inherently wrong with family based methods of capital financing, studies such as those by Mostafa (2005) stated that it often came with certain conditions related to the types of business that can be gone into by female entrepreneurs [5]. This often entailed clothing, textiles, and manufacturing that were often detailed as the â€Å"traditional domain† of female entrepreneurs within the UAE. This conditional funding through family based methods of capital development can actually be considered a limiting factor in the capacity for female entrepreneurs to establish themselves in new types of business and, as such, can be considered a detrimental feature of the current â€Å"entrepreneurial funding† system within the UAE [13]. Analysis of Government Policy Initiatives An analysis of government policy initiatives that were mentioned in the Haan article showed the presence of gender specific barriers in entrepreneurship wherein male sponsorship, male networking and overall male assistance was required when it came to women entering into any form of entrepreneurial activity. The problem with the implementation of male sponsorships is that it is not needed in the case of women entrepreneurs since males basically just sign their signatures on a piece of paper [59]. They are not partners in the business nor do they take an active role in it; basically the Haan article shows that men are just there to show that there is a level of biased gender supervision occurring. Through the work of Madsen (2010), it was revealed that at the present, there have been no government policy initiatives to address such issues with the same policies continuing to exist [60]. Contributing to this problem is the lack of sufficient government funding in the development of female support networks which are there to help women in connecting with each other and developing the necessary relationships to grow and expand their business. While it may be true that the UAE government states that it actively promotes female entrepreneurship and even gives awards to prominent female entrepreneurs, the fac t remains that the current policy system within the region suffers from significant gender specific biases. This creates barriers towards the creation of a better business environment for female entrepreneurs [6]. In a presentation, a number of things have changed over these ten years, yet the issue concerning women in business somehow remains just as unsolved as it used to be, mostly because the basic initiatives still revolve around introducing agencies that will help regulate the issue within the market. However, certain changes are definitely worth being mentioned. While the issue regarding women in the UAE business still leaves much to be desired, considerable concessions have been made over the past decade. The initiatives of the UAE government To start with, the formation of the Khalifa Fund can be considered the stepping stone of female empowerment in business in the UAE. Khalifa Fund was created in 2007 in Abu Dhabi, UAE. The fund was originally intended to help SMEs and en courage the development of small businesses across the country. Offering to invest in new and promising industrial and service sectors within the Abu Dhabi area, the fund allowed for small business growth. Funded by the government, the organization reflects the attempts of the latter to change the UAE business landscape. In 2012, the organization announced its determination to invest in microbusinesses [61], [62], [63], [64]. In fact, the given organization can be considered by far the most supportive and efficient of all; being one-of-a-kind project, it provides â€Å"venture capital, training, development, data and consulting services, and even marketing support† [3], which is very impressive. However, financial assistance does not have a tangible impact on the Emirati society and its concept of women in business: â€Å"However, unlike other countries, there is a lack of support targeting female entrepreneurs in UAE† [4]. Recently, the organization has been paying sp ecial attention to women in business. In 2013, nearly 30% of $14 m was provided to allow for more options for UAE women in SME. At present, the Khalifa Fund is tackling the issue quite efficiently. However, there is still a long way for the Khalifa Fund to go in order to provide UAE women with the same options as men have in business. What is necessary is the development of better policy initiatives in not only removing gender barriers in entrepreneurial activity, but also in developing the necessary networks for female entrepreneurs to thrive [65], [66], [67], [68]. Furthermore, there are organizations that enable female entrepreneurs find experienced mentors. For example, one can mention Ro’Ya. Secondly, it is possible to mention the organizations that assist females in developing their leadership skills. In particular, one can refer to Dubai Business Women Establishment. Research Plan Methodology The methodology that will be utilized within this particular research will be , a serial of questions sent to a variety of female entrepreneurs within the UAE. In order to determine the various difficulties they experience on a daily basis when it comes to entrepreneurial activities. To achieve statistical significance results and conclusions, we chose the initial number of surveys distributed to be 200 with the goal of obtaining 100 useful responses. Survey In women business owners in the United Arab Emirates, 2007 paper, 44 survey questions were analyzed in their study [21]. Haan conducted a survey of 30 questions in his UAE women entrepreneurs’ paper [13]. In this research a similar set of questions will be incorporated in the survey. To provide solid and statistically useful data, around 200 candidates will be asked to answer these questions. Then an analysis of the results obtained in this step will be made. This all will help us perform a sampling campaign for candidates of the next step. Personal Interviews Thenwe will narrow down the number of candidates, to a reasonable number of candidates from UAE women business owners, to conduct personal interviews with them in order to obtain qualitative assessments of the factors explored in the survey. We will be choosing candidates who follow a certain pattern, to better measure the problem in hand. The candidates will be sharing their experiences before and after they started their businesses. For instance they will talk about the challenges, opportunities, and the support they needed to make their businesses a success. Mentioning strategies that helped them succeed as entrepreneurs, despite the constraints that acted as barriers. Again all information gathered will be analyzed for the in depth interviews. In Depth Interviews This will be the last step on the methodology, and the number of candidates will get even smaller than step 2, because the questions in this stage will get more specific and detailed and more personal. All information that will be obtained via any method of the data gathering will be kept strictly confidential.. Their feedback would give a huge impact on the recommendation section of this research. The Gantt chart demonstrates the monthly milestones of the research for spring semester. Gantt Chart Appendixes The initiatives of the UAE Government Name of the Initiative Intention Khalifa Fund This initiative is aimed at providing investment opportunities for the owners of small businesses Abu Dhabi Business Women Council This organization strives to help women better cope with the role of entrepreneurs Ro’Ya This program has been launched to enable female entrepreneurs showcase their business projects and find mentors. Dubai Women Establishment The goal of this organization is to assist women with the development of leadership skills. International Business Women’s Group This organization supports the networking of female entrepreneurs. References [1]. Y. Itani, S. Yusuf, and I. Baalbaki. United Arab Emira tes Female Entrepreneurs: Motivations and Frustrations. Equality, Diversity Inclusion, vol. 30, no.5, pp. 409-424, 2011 [2]. G.V. Priscilla, and M.S. Erogul. Female Entrepreneurship in the United Arab Emirates: Legislative Encouragements and Cultural Constraints, Womens Studies International Forum, vol. 34, no. 4, pp. 329-334, 2011. [3]. Z.J. AÃŒ cs and S. LaÃŒ szloÃŒ . The Global Entrepreneurship Index (GEINDEX), Boston: Now Publishers, 2009. [4]. S. Vossenberg. â€Å"Women Entrepreneurship Promotion in Developing Countries: What explains the gender gap in entrepreneurship and how to close it?† Web. Available: msm.nl/getattachment/e94b7b38-e17b-4c5d-b497-c4135be7ec86. [5]. 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Entrepreneurship and Economic Growth, Oxford: Oxford University Press, 2006. [28]. Gedmin Jeffrey and Gamester Nathan, U.S. Prosperity Is in Decline; The latest data on economic well-being show the biggest slide in entrepreneurship and opportunity. Businesses start-up costs are rising in the land of pioneers and patents., Wall Street Journal (Online), 2012, Retrieved from http://search.proquest.com/docview/1115586367?accountid=1611. [29]. J. Winn. Women entrepreneurs: can we remove the barriers? The International Entrepreneurship and Management Journal, vol. 1, no.3, pp. 381-397. [30]. C. Hossan, M. Parakandi, and H. Saber. â€Å"Entrepreneurial Knowledge, Preferences and Barriers of Female Business Students in the Middle East,† Journal of Business and Policy Research, vol. 8, no.2, pp. 83-99, 2013. [31].A. Abdelkarim. Employment and Employability in a Small Oil Economy-the UAE, Maastricht, the Netherlands: Shaker Publishers, 2001. [32].J. Kunnanatt. 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Journal Of Leadership Organizational Studies (Sage Publications Inc.), vol. 17, no.1, pp.100-110, 2010 [39]. Typology of Career Development for Arab Women Managers in the United Arab Emirates. Career Development International, vol. 15, no.2, pp. 121-143, 2010 [40]. M. Mostafa. Attitudes towards Women Managers in the United Arab Emirates: The Effects of Patriarchy, Age, and Sex Differences. Journal Of Managerial Psychology, vol. 20, no.6, pp. 522-540, 2005 [41]. Rob Mcsherry, Innovation in Nursing Practise: A Means to Tackling the Global Challenges Facing Nurses, Midwives and Nurse Leaders and Mangers in Future, Journal of Nursing and Management, pp. 165-169, 2011. [42]. V. Mathew. Women entrepreneurship in Middle East: understanding barriers a nd use of ICT for entrepreneurship development, International Entrepreneurship and Management Journal, vol. 6, no.2, pp. 163-181, 2010. [43]. Thomas R. Eisenmann, Entrepreneurship: A Working Definition, Harvard Business Review, p. 1, January 2013. [44]. Erick A. Borg and Karl Gratzer, Theories, Brands and Entrepreneurship: Conceptualising Brand Strategies, in 3rd Annual InterNational Conference on Business Strategy and Organizational behaviour, Huddinge, Sweden, 2013, p. 58. [45]. Masdar Institute. (2013) Masdar Institute.Web. masdar.ac.ae/Industry.html [46]. Erick A. Borg and Karl Gratzer, Theories, Brands and Entrepreneurship: Conceptualising Brand Strategies, in 3rd Annual InterNational Conference on Business Strategy and Organizational behaviour, Huddinge, Sweden, 2013, p. 58. [47]. S.Z. Ahmad. Evidence of the characteristics of women entrepreneurs in the Kingdom of Saudi Arabia: an empirical investigation, International Journal of Gender and Entrepreneurship, vol. 3, no.2, pp. 123-143, 2011. [48]. M. 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The Present Tense of Verbs in English Grammar

The Present Tense of Verbs in English Grammar In English grammar, a present tense is a form of the  verb  occurring in the current moment that is represented by either the base form  or the -s  inflection  of  the third-person singular, contrasting with the past and future tenses. The present tense may also refer to an action or event that is ongoing or that takes place at the present moment. However, because the present tense in English can also be used to express a range of other meanings- including references to the past and future events, depending on the context- it is sometimes described as being unmarked for time.   The basic form of the present indicative is commonly  known as the simple present. Other verbal constructions referred to as present include the present progressive  as in are laughing, the present perfect  as in have laughed, and the present perfect progressive  as in have been laughing.   Functions of the Present Tense There are six common ways to use the present tense in English, though the most common function is to designate an action that is occurring at the time of speaking or writing like she lives in the house or to indicate habitual actions like I run every morning, and in some cases may be used to express general truths like time flies, scientific knowledge like light travels, and when referring to texts like Shakespeare says a rose by any other name would still smell as sweet. Robert DiYanni and Pat C. Hoy II note in the third edition of The Scribner Handbook for Writers that present tense also has some special rules for their usage, especially when indicating future time wherein they must be used with time expressions like we travel to Italy next week and Michael returns in the morning. Many authors and literary scholars have also noticed a recent trend in literary works to be written in the hipper present tense, whereas most works of great literature are written in the past tense. This is because modern literature relies on the use of the present tense to convey a sense of urgency and relevance to the text. The Four Present Tenses There are four unique forms of the present tense that can be used in English grammar: simple present, present progressive, present perfect, and present perfect progressive. The simple present is the most common form, used primarily to express facts and habits, detail the action of scheduled future events and to tell stories in a more compelling and engaging manner than past tense entails. In the present progressive sentences, a linking verb is often attached to the present progressive verb to indicate events that are ongoing in the present, such as I am searching or he is going while the present perfect tense is used to define actions that began in the past but are still ongoing like I have gone or he has searched. Finally, the present perfect progressive form is used to indicate a continuous activity that started in the past and is still ongoing or has recently been completed as in I have been searching or he has been depending on you.

Decision Making using Critical Thinking Assignment

Decision Making using Critical Thinking - Assignment Example The inhabitants of the country are an ethnic mix of indigenous South Pacific tribes, Asians particularly Chinese, African, French, Spanish and Americans. In designing the strategies for the company, it must take into consideration the different culture, beliefs and values of the residents of Kava. While most of these people are known coffee drinkers, the tastes and preferences might vary. Another challenge which the company faces is the threat of disasters which often confront the people of Kava. This phenomenon greatly impacts on the economy of Kava, which in turn affects the buying behavior and purchasing power of the people of Kava. Buying specialized coffee might not be one of their priorities if they hardly have food to eat on their table. However, there also presents an opportunity for the company for the untapped â€Å"foreign† or expat market whose income are barely affected by the disasters that are experienced by the people of Kava. Finding the right mix of people to be employed by the company is another issue that besets the company. Being an employee for the company means forging a partnership with the organization. It is therefore imperative that the people to be hired by the organization must share the same mission and vision as what the company holds. They should be willing to learn and grow with the company. Building a profitable organization in Kava means having to work harmoniously with the government. The company must be ready to help support the different communities in Kava. The organization must be ready to create partnerships with other organizations to improve the lives of the people of Kava. There several forces involved in the formulation of the problem. Specifically, the problem on hand is about establishing a greater presence in Kava. One of the forces involved in the formulation of the problem is the leadership of Chris. One is

Project management Essay Example | Topics and Well Written Essays - 2000 words - 10

Project management - Essay Example The aim of this report is to develop a project management plan for Biz Group based on the project problem statement identified above. Project is defined as â€Å"a unique, finite set of multiple activities intended to accomplish a specific goal† (Tayntor, 2010:3). Practically every project is comprised of key milestones which represent a simple life cycle. Project life cycle is characterized by the Project Management Institute’s PMBOK as a process containing the following key levels: Project StartïÆ'  Initiating Processes ïÆ'   Planning Processes ïÆ'   Executing Processes ïÆ'   Closing Processes ïÆ'   Project End (Kendrick 2010:58). Project management plan is based on three key pillars (scope, time, and money), forming thus a triangle of three objectives. However, in order to start any project it is necessary to receive authorization of the project. Project Authorization is a general process of verifying a proposed project for initiation and further development, which aims to confirm feasibility and cost-effectiveness of the project (Taskmanagementguide.com, 2014). The Charter of the Project is recognized to be the single most important document in a project, as it establishes the project and summarizes the key information related to the project (Tayntor, 2010). The project â€Å"Documentum† was initiated by the Biz Group management with the purpose to implement a standardized process for monitoring, updating and publishing unstructured and paper based content used in various department manuals by providing an automated system. Below is provided a brief summary of the Project â€Å"Documentum† Project Objective: to automate the Manuals and Training material, approval process with the help of workflows and finally publish it to all relevant applications, documents and people thorough electronic means CEO of Biz Group: The CEO of Biz Group

Literature as Knowledge for Living Essay Example for Free

Literature as Knowledge for Living Essay According to Vera M. Kutzinski in his introduction, Ottmar Ette was sent to the east of Germany after the reunification of Germany to strengthen academic institutions. There, universities were going to receive the so-called â€Å"Initiative for Excellence†, which would make German universities more competitive. But, when it came to application, a little percentage of humanities institutions were selected, because the focus was actually on science and technology. This fact was what fueled Ette to take a turn on his work and started to work on not trying to convince why literary studies were better or worth more attention or research, but to make skeptical see why society cannot do without literary studies. Ette’s official work on this matter is titled Lendemains, where he focuses on literary studies as something that society needs to survive and the relations established between human beings in literary terms. Below is presented a short review on his evaluation on this matter. Ette argues that literature and language do not seem to deal with language about life any longer. Instead, scientific and technological academic fields have taken over. So what has to be done for the humanities to deal with life again would be, according to him, reorientating the idea of life, which should be based on making society see how the humanities can improve how human beings live with one another, and this should be done together with the biosciences, creating an easily understandable language which allowed scientific and literary discourses to work together as equals. Ette also discusses how biotechnology and natural-scientific fields of study have become the â€Å"sciences of life† because it has been socially accepted, since their subjects of study have to do with life. And also how literary scholars do not pay attention to the humanities losing ground on this respect. So, according to the author, the concept of life should be changed from a bio-chemical, biophysical, and biotechnological and medical, to a cultural-literature-oriented one, as other scholars also maintained before (Leo Spitzer and his ideal of literature being the science that seeks to comprehend the human being to the extent to which he expresses himself in words and linguistic creations). Then, the author introduces the concept knowledge for living as the kind of knowledge inherent to literature, this is, literature having knowledge about or of life. But then, it comes the following question: how to acquire this knowledge for living? This could be answered (according also to Wolfgang Iser’s work) by the act of reading, this is: reading fictional literary pieces and having experiences through it that make the reader gain a kind of knowledge that he/she would not experience in their own life otherwise. This introduces the concepts of intratextuallity (the knowledge of living that characters of novels possess) and extratextuallity (the ways of acquiring certain cultural and sociohistorical knowledge for living), both of which influence the reader culturally, in their behavior, their life, etc. depending on what they read. These two dimensions of the knowledge for living constitute, at the same time, the knowledge for living together, which is acquired by the readers through literature as the conditions for people to live together which have been shaped all throughout history. In these terms, the author mentions Roland Basthers’ work Comment vivre ensemble, and how literary analysis could connect literature and life. This is, for example, how to live (in the novel), how certain people have lived (in biography), etc. In addition, these knowledges should take into account different contexts and cultures, gender and social differences, in order to be universal and valid. The conclusion of the author is that the humanities first need to realize the potential that they possess concerning knowledge for living which, in conjunction with the natural and social sciences, would give new perspectives for the exploration of art and literature as knowledge for living.

Hamlets Themes Revived in Great Expectations :: Great Expectations Essays

Hamlet's Themes Revived in Great Expectations      Ã‚  Ã‚  Ã‚   Many of Hamlet's themes are revived in the text of Great Expectations. Charles Dickens creates characters and plots that are intertextually linked with the elements of the fatherly ghost and revenge in Hamlet. Pip chronicles his quest for self-discovery and establishing and/or diminishing his relationships with fatherly figures. In doing so he, much like Hamlet, is challenged by situations filled with revenge and dauntless ghosts. By Dickens integrating the Hamlet motif into Great Expectations, he promotes the reader's understanding of the dominant themes and message of Pip's tragedy, which directly correlate to the character of Prince Hamlet. Dickens makes references to Hamlet throughout the novel, but he establishes strong parallels particularly in the first and thirty-first chapters of his novel. Furthermore, Dickens dedicates chapter thirty-one to an actual performance of the play. He connects the roles the reader is to recognize Pip portraying in hi s life to the actors and scenes being comically reenacted on stage. In order for Dickens to emphasize Pip's inconsistent identity, he relies on a commentary on each of the boy's attempts to play the role of someone else. Besides the resonance of Prince Hamlet in Pip's character, the fatherly figures of Joe and Magwitch are drawn in the image of the Ghost of Hamlet's father. Both Hamlet and Great Expectations bear the struggles of young men striving to fulfill their obligations to a vengeful father figure. The fatherly figures propel their "sons" to attain the place in society which they lacked a chance to themselves, but the fatherly intentions only lead to Hamlet and Pip's self-destruction. Hamlet is defeated by his contempt and lust to satisfy the revenge his father seeks through him. In Great Expectations, Pip is given the fortunate opportunity to escape the constraint of revenge; despite a difficult journey, he ultimately succeeds in becoming a gentleman. Pip, unlik e Hamlet, learns to avoid the vengeful behavior which soured his expectations; rather he accepts the just father figure of Joe and distinguishes his identity.    Parallels to Hamlet can be drawn throughout the text of Great Expectations, but the issues that relentlessly plague Pip and Hamlet are both introduced in the novel's first chapter.

Operation System Security Essay

1. What are the relative advantages and disadvantages of at least three different measures used to protect operating systems? 2. The ease of implementation of the measures. 3. The associated security management issues related to measures discussed above. 4. The ranking of the measures from best to worst with supporting rationale Answer Antivirus: Antivirus is the easiest protective measure that can be implemented on an operating system, and is also usually very easy to maintain. An update schedule is scheduled, or the antivirus software is configured to be managed by a central antivirus server which disseminates updates and virus signatures. Having an up-to-date anti-virus is always a good idea; it doesn’t take much work, and offers a decent amount of protection. Image-Locking software: This type of solution which exists in software such as Deep Freeze takes an image of the computer on startup to which it reverts after each restart. While this does little to prevent the computer from being compromised, it provides the ability to undo all changes, including any changes an attacker may have made, by restarting the computer. This is more difficult to implement, and is not an acceptable solution on hosts that need to maintain dynamic information, such as a database, as it would lose all new information entered since the image was created on reboot. Host Intrusion Detection System: A Host Intrusion Detection system is similar to Antivirus in that it looks for suspicious activity and compares against a definition file, but it also inspects network traffic that comes through the local interface. This allows the HIDS to detect an attack before it has actually put anything on your computer. HIDS also creates a host baseline, to which changes are reported to an administrator. This can result in a lot of logs if changes are made on a regular basis. This solution is both difficult to configure and maintain. In a real environment, you aren’t restricted to using a single solution. If you have the resources to support it, running multiple Antivirus programs is suggested as different vendors may publish definitions earlier than others. Antivirus can also be used in tandem with the other solutions, creating a more secure host

Essay of Ancient China

Ancient China In ancient Chinese cosmology, the universe was created not by divinities but self-generated from the interplay of nature's basic duality: the active, light, dry, warm, positive, masculine yang and the passive, dark, cold, moist, negative yin. All things, animate and inanimate, and all circumstances were a combination of these fundamentals. The ultimate principle of the universe was the tao, â€Å"the way,† and it determined the proper proportions of yin and yang in everything. Anything that altered the natural relation of yin to yang was considered bad, and right living consisted of carefully following the tao.If one observed the tao by moderation, equanimity, and morality, as taught in the Tao-te Ching, by Lao-tzu (sixth century B. C. ), one would be impervious to disease and resistant to the ravages of aging; disregard of the tao led to illness, which was not so much a punishment for sin as the inevitable result of acting contrary to natural laws. However, illn ess also could be caused by forces beyond one's control: â€Å"Wind is the cause of a hundred diseases,† and atmospheric conditions could upset the harmonious inner balance of the yang and yin.One had to be alert to this possibility and combat its effects as well as modify internal imbalances of the vital forces. Longevity and health were the rewards. Chinese medicine, in league with Taoism, was focused on the prevention of illness; for, as the legendary Huang Ti, father of Chinese medicine, observed, â€Å"the superior physician helps before the early budding of disease. † Although Taoist hygiene called for temperance and simplicity in most things, sexual mores were governed by the yin-yang aspect of Chinese philosophy.Ejaculation in intercourse led to diminution of a man's yang, which, of course, upset the inner balance of his nature. On the other hand, one was strengthened by absorption of the yin released by the orgasm of one's female partner—unless she was over thirty, the point where female essence lost its efficacy. The tao was important in Confucianism also, as the path of virtuous conduct, and for centuries the precepts of Confucius (K'ung Fu-tzu, 550-479 B. C. ) set the most prevalent standards of behavior. In early Chinese philosophy, there was a tendency to accept and combine aspects of all religions and to make way for new ideas.Nevertheless, the ancient Chinese were profoundly conservative once an institution, custom, philosophy, mode of dress, or even a furniture style was firmly established, and it remained relatively unchanged over centuries. As Confucius said: â€Å"Gather in the same places where our fathers before us have gathered; perform the same ceremonies which they before us have performed; play the same music which they before us have played; pay respect to those whom they honored; love those who were dear to them. † Although ancient China's development was relatively isolated, there was early contact with India and Tibet.Buddhism came to China from India, and medical concepts and practices were an important part of its teachings. The gymnastic and breathing exercises in Chinese medical methodology also came from India and were closely related to the principles of Yoga and to aspects of Ayurvedic medicine. There were also contacts with Southeast Asia, Persia, and the Arabic world. In the second century B. C. , the Chinese ambassador Chang Chien spent more than a decade in Mesopotamia, Syria, and Egypt, bringing back information on drugs, viticulture, and other subjects.Over the centuries, knowledge of humoral medicine and of numerous new medicaments filtered into China. The introduction of the wisdom of the Mediterranean world was greatly facilitated in the fifth century by the expulsion and wide dispersion from Constantinople of the heretical Nestorian Christians. The mother of Kublai Khan (1216-94), founder of the Mongol dynasty, was a Nestorian and asked the Pope to send European d octors to China. Early Medical Writings Classical Chinese medicine was based primarily on works ascribed to three legendary emperors. The most ancient was Fu Hsi (c. 2900 B. C. , who was said to have originated the pa kua, a symbol composed of yang lines and yin lines combined in eight (pa) separate trigrams (kua) which could represent all yin-yang conditions. This system is followed even today in the I Ching (Book of Changes), though as a game or superstition in the West. Shen Nung, the Red Emperor (Hung Ti), compiled the first medical herbal, the Pen-tsao (c. 2800 B. C. ), in which he reported the effects of 365 drugs, all of them personally tested. One legend explains that a magic drug made his abdominal skin transparent, so he could observe the action of the many plants he evaluated.Another story tells that he cut open his abdomen and stitched in a window. Shen Nung is also said to have drawn up the first charts on acupuncture, a medical procedure presumably even older than the legendary emperors. The fame of Yu Hsiung (c. 2600 B. C. ), the Yellow Emperor (Huang Ti), rests on his great medical compendium, the Nei Ching (Canon of Medicine). Transmitted orally for many centuries, this seminal work was possibly committed to writing by the third century B. C. Its present form dates from the eighth century A. D. when the last extensive revision was done by Wang Ping. The major portion of the Nei Ching, the Sun-Wen (Simple Questions), records the discourse of the Yellow Emperor with Ch'i Po, his prime minister, on virtually all phases of health and illness, including prevention and treatment. The section called Ling-Hsu (Spiritual Nucleus), deals entirely with acupuncture. Yu Hsiung also was said to be responsible for another great compendium, The Discourses of the Yellow Emperor and the Plain Girl, which thoroughly covered the subject of sex from the Taoist point of view.Among other notable sources for ancient medical lore, one might mention the Shih Ching (Boo k of Odes), which perhaps predates Homer's epics, and the Lun-yu, discourses of Confucius probably written down shortly after his death, which affected patterns of behavior for many generations. During the long Chou dynasty (c. 1050-255 B. C. ), a lengthy compilation of medical works, Institutions of Chou, was completed and became the criterion for subsequent dynasties on the duties and organization of physicians. In the Han dynasty (206 B. C. -A. D. 20), there was a noted clinical author named Tsang Kung, who pioneered in the description of many diseases, including cancer of the stomach, aneurysm, and rheumatism. Chang Chung-ching, the Chinese Hippocrates, in the third century A. D. , wrote the classic treatise Typhoid and Other Fevers. Ko Hung, a famed alchemist and a careful observer, wrote treatises describing beriberi (a vitamin B deficiency), hepatitis, and plague, and gave one of the earliest reports on smallpox: â€Å"As the New Year approached there was a seasonal affectio n in which pustules appeared on the face and spread rapidly all over the body.They looked like burns covered with white starch and reformed as soon as they were broken. The majority died if not treated. After recovery purplish black scars remained. † Sun Szu-miao (A. D. 581-682) wrote Ch'ien Chin Yao Fang (A Thousand Golden Remedies), which summarized in thirty volumes much of the known medical learning, and he headed a committee which produced a fifty-volume collection on pathology. An extensive codification of forensic medicine, Hsi Yuan Lu, was done in the Sung dynasty and became the prime source for knowledge of medical jurisprudence.Anatomy and Physiology Ideas of anatomy in ancient China were reached by reasoning and. by assumption rather than dissection or direct observation. Since the doctrines of Confucius forbade violation of the body, it was not until the eighteenth century, long after Vesalius, that the Chinese began systematic, direct anatomical studies. Even as l ate as the nineteenth century, in the Viceroy's Hospital Medical School, anatomy was taught by diagrams and artificial models rather than dissection.Physiological functions were constructed into a humoral system much like Greek concepts of the sixth century B. C. and Galenic views of the second century A. D. , except that there were five instead of four essential humors. (The number five had mystical value for the Chinese and was used for most classifications: five elements, five tastes, five qualities, five kinds of drugs, five treatments, five solid organs, five seasons, five emotions, five colors, etc. ) The medical compendium Nei Ching stated that each emotion had its seat in a particular organ.Happiness dwelt in the heart, thought in the spleen, sorrow in the lungs, and the liver housed anger as well as the soul. Ideas in the Nei Ching concerning movement of the blood (â€Å"All the blood is under control of the heart. † â€Å"The blood current flows continuously in a c ircle and never stops. â€Å") have been thought to approach an understanding of its circulation antedating Harvey by thousands of years; however, some body vessels were believed to convey air, and there is little evidence that commentators perceived the blood-carrying vessels as a contained system. DiagnosisThe Chinese methods of diagnosis included questioning, feeling the pulse, observing the voice and body, and in some circumstances touching the affected parts. In almost all times and cultures physicians have used a similar approach, for all healers have sought to know as much as possible about a patient in order to understand his or her illness and advise treatment. However, in some respects ancient physicians saw each patient more completely as a reflection of his surroundings (indeed, the entire universe) than does the doctor of today. The Chinese doctor wanted to learn ow the patient had violated the tao, and to do this he took into account the patient's rank; changes in his or her social status, household, economic position, sense of well-being, or appetite; the weather; and the dreams of the patient and his or her family. Perhaps the most important diagnostic technique of the ancient Chinese was examination of the pulse. The physician felt the right wrist and then the left. He compared the beats with his own, noting precise time as well as day and season since each hour affected the nature of the pulsations.Each pulse had three distinct divisions, each associated with a specific organ, and each division had a separate quality, of which there were dozens of varieties. Moreover, each division or zone of the pulse had a superficial and deep projection. Thus literally hundreds of possible characteristics were obtainable. In one treatise, Muo-Ching, ten volumes were necessary to cover all the intricacies of the pulse. A patient had only to extend his or her arm through drawn bed curtains for the physician to determine the symptoms, diagnosis, prognosis, a nd proper treatment by intensive palpation of the pulse.Whenever possible the examiner also felt the skin of the ill person. However, it was considered bad form for a man to intimately examine a woman, so special ceramic, ivory, and wooden dolls were pointed to by the invalid to indicate where discomfort was felt. Treatment According to the Nei Ching, there were five methods of treatment: cure the spirit, nourish the body, give medications, treat the whole body, and use acupuncture and moxibustion. The physician had to put the patient back on the right path, the tao.Assuming that specific mental states caused changes in specific organs, the healer linked certain objectionable behavioral and constitutional factors with illness and attempted to have the patient rectify these. For instance, dissolute and licentious ideas led to diseases of the lungs, but acting out such thoughts brought on heart trouble. A doctor had to determine the cause of disharmony in the body and act accordingly. Exercises were developed to keep the body fit and to restore well-being. Hua T'o, the great surgeon, worked out an ingenious system of physical therapy by advising mimicry of the natural movements of animals.Massage—kneading, tapping, pinching, and chafing—was also a regular method of treatment, as were the application of plasters and evacuation of the intestinal tract by cathartics. In nourishing a patient's body, the physician resorted to complex combinations of foods according to their potential amounts of yang and yin. Foods also had to fit the seasons, and each of the five tastes had benefits for a particular element of the body: sour for the bones, pungent for the tendons, salty for the blood, bitter for respiration, and sweet for muscle.Medications The Chinese pharmacopoeia was always rich, from the time of the Pen-tsao, the first medical herbal, to the later dynasties when two thousand items and sixteen thousand prescriptions made up the armamentarium. Drugs w ere considered more likely to be good if they tasted bad. As one would expect, they were classified into five categories: herbs, trees, insects, stones, and grains. The therapeutic minerals and metals included compounds of mercury (calomel was employed for venereal diseases), arsenic, and magnetic stones.Animal-derived remedies, in addition to â€Å"dragon teeth† (powdered fossilized bones), included virtually anything obtainable from living creatures: whole parts, segments of organs, urine, dung. Two plant substances especially associated with China may be singled out. One is ephedra (ma huang), the â€Å"horsetail† plant described by the Red Emperor, which was used for thousands of years as a stimulant, as a remedy for respiratory -diseases, to induce fevers and perspiration, and to depress coughs.Ephedra entered the Greek pharmacopoeia and eventually was disseminated throughout most of the world. It only became a factor in Western medicine in the late nineteenth cen tury after Japanese investigators isolated and purified the active principle, ephedrine, and established its pharmacologic action. A second medicinal herb, always highly popular among the Chinese, is ginseng (â€Å"man-shaped root†). To the Chinese, preparations containing ginseng were almost miraculous in delaying old age, restoring sexual powers, stimulating the debilitated, and sedating the overwrought.In addition it improved diabetes and stabilized blood pressure. In recent years this root has been under scrutiny by Western pharmacologists attempting to evaluate its true benefits. Multitudes in Asia, and even some Westerners, are so convinced of its effectiveness that high-grade wild roots have brought fabulous prices (even reaching thousands of dollars apiece). Although many items in the Chinese materia medica have either faded into bscurity or been labeled fanciful, others subsequently have been found to possess sound pharmacologic bases: seaweed, which contains iodine, was used in treating enlargement of the thyroid; the willow plant, containing salicylic acid, was a remedy for rheumatism; the Siberian wort has antispasmodics for menstrual discomfort; and mulberry flowers contain rutin, a treatment for elevated blood pressure. Whether opium was used as a drug before quite late in Chinese history is still in dispute. Acupuncture and Moxibustion These modalities have been an integral part of Chinese medical therapy for thousands of years.The Yellow Emperor is said to have invented them, but they may well have existed long before his time. The aim of these treatments was to drain off excess yang or yin and thus establish a proper balance, but external energy also could be introduced into the body. In acupuncture the skin is pierced by long needles to varying prescribed depths. Needles are inserted into any of 365 points along the twelve meridians that traverse the body and transmit an active life force called ch'i. Each of these points is related to a particular organ.For instance, puncture of a certain spot on the ear lobe might be the proper way to treat an abdominal ailment. Virtually every illness, weakness, and symptom is thought to be amenable to correction by acupuncture. Acupuncture spread to Korea and Japan by the end of the tenth century A. D. , to Europe about the seventeenth century, and recent years have seen a wider interest in this Chinese medical practice in the West. Individual paramedical healers and even some medical practitioners have been swamped with requests for acupuncture, especially for problems apparently little benefited by conventional practices.The eventual acceptability of this practice in standard Western medicine remains to be seen. Moxibustion is as old as acupuncture, and the same meridians and points govern placement of the moxa. However, in this treatment a powdered plant substance, usually mugwort, is fashioned into a small mound on the patient's skin and burned, usually raising a blister. Dentistry The treatment of tooth disorders was confined mainly to applying or ingesting drugs—pomegranate, aconite, ginseng, garlic, rhubarb, and arsenic, as well as animal products such as dung and urine.The Nei Ching classified nine types of toothaches, which included some obviously due to infections and tooth decay. Like the Mesopotamians and Egyptians, the ancient Chinese believed that worms were often responsible for dental problems. Toothpicks and tooth whiteners were used, and loose teeth were stabilized with bamboo splints. Gold was sometimes used to cover teeth, but the purpose was decorative rather than protective. Surgery Although surgery was not one of the five methods of treatment listed in the Nei Ching, the knife was known and used.Hua T'o, one of the few names mentioned in connection with surgery, treated an arm wound of the famous general Kuan Yu by cutting his flesh and scraping the bone. Physicians knew how to deal with wounds, and at least two classics we re devoted entirely to their treatment. The proper attitude toward pain was to bear it without a sign of emotion, and much was made of the insouciance of the general treated by Hua T'o; he played chess while the surgeon operated. Nevertheless, apparently some kind of anesthesia was often used.Wine and drugs like hyoscyamus were probably mainstays, but the use of opium and Indian hemp is still in question. Eunuchs and Footbinding Another surgical procedure, though hardly therapeutic, was the frequent castration of certain males seeking advancement at court. Though originally a severe punishment, the total removal of penis and testicles came to be a pledge of absolute allegiance to the monarch, since it released the eunuch from conflict with Confucian admonitions of first loyalty to family and the obligation of siring a son for posterity.Footbinding is also of medical interest, for it caused the development of artificially clubbed feet. Over a period of one thousand years, every young girl of proper family willingly permitted herself to be crippled by her mother and aunts to achieve the tiny foot of ideal feminine beauty. Her toes were gradually folded under the sole, and by increasingly tight bandaging her heelbone and forefoot were brought closer together. Without Golden Lotuses, as the best-shaped bound feet were called, a girl was unmarriageable, nor was the life of a courtesan open to her, for tiny feet were a woman's most desirable feature.For a man, a bound-foot wife had profound sexual significance, but she was also a status symbol inasmuch as her helplessness indicated that he was wealthy enough to support a woman, or women, in idleness. There was also an advantage to him in her restricted mobility, for it kept her home and made illicit amorous adventures difficult. Although China's Manchu conquerors forbade the practice in the nineteenth century, it was not until the early twentieth that footbinding was completely abandoned. Diseases Some epidemic dise ases were understood well enough to allow the development of protective measures.In the eleventh century, inoculation against smallpox was effected by putting scabs from smallpox pustules into the nostrils, a method which may have come from India. Wearing the clothing of someone who had the disease was another means of prevention. The relationship of cowpox (as a protective) to smallpox may have been perceived, since ingesting powdered fleas from infected cows was also recommended to stave off smallpox. But other devastating pestilences were neither understood nor held in check. During the Han dynasty an epidemic of what appears to have been typhoid fever killed two-thirds of the population of one region.Precise descriptions of leprosy in the Nei Ching and later works attest to the diagnostic accuracy of the early Chinese healers, but their explanation of the disease's causes and their treatment follow preconceived notions of the time. â€Å"The wind and chills lodge in the blood v essels and cannot be got rid of. This is called li-feng. For the treatment prick the swollen parts with a sharp needle to let the foul air out. † Fourteenth-century writings referred to chaulmoogra oil, a pressing from seeds of an East Indian tree, as a specific for leprosy, and this oil remained the principal antileprous drug even in the West until recent decades.An illness that may have been tuberculosis was recognized as contagious: â€Å"Generally the disease gives rise to high fever, sweating, asthenia, unlocalized pains making all positions difficult and slowly bringing about consumption and death, after which the disease is transmitted to the relations until the whole family has been wiped out. † Venereal diseases, although not well differentiated, received a variety of therapies, including the use of metallic substances for internal medication.In the Secret Therapy for the Treatment of Venereal Disease, the seventeenth-century physician Chun Szi-sung reported us ing arsenic, which, until the development of penicillin, was the modern medication for venereal disease, in the form of Salvarsan and derivatives synthesized by Paul Ehrlich. There seem always to have been places in China where the sick poor could go for medical care. With the advance of Buddhism in the Han and T'ang dynasties, in-patient hospitals staffed by physician-priests became common.However, in the ninth century, when anti-Buddhists were in control, hospitals as well as 4,600 temples were destroyed or emptied. Nevertheless, by the twelfth century hospitals had again become so numerous that virtually every district had at least one tax-supported institution. The upper classes preferred to be treated and cared for in their homes, thus leaving public hospitals to the poor and lower classes. The Practitioners In the Institutions of Chou, compiled hundreds of years before Christ, the hierarchy of physicians in the kingdom was delineated.The five categories were: chief physician ( who collected drugs, examined other physicians, and assigned them); food physicians (who prescribed six kinds of food and drink); physicians for simple diseases (such as headaches, colds, minor wounds); ulcer physicians (who may have been the surgeons); and physicians for animals (evidently veterinarians). Physicians were also rated according to their results, and as early as the Chou and T'ang dynasties each doctor had to report both successes and failures—to control his movement up or down in the ranks.In the seventh century A. D. examinations were required for one to qualify as a physician, some four centuries earlier than the first licensing system in the West. Medical knowledge was thought of as a secret power that belonged to each practitioner. Whereas in other societies, both advanced and primitive, closely knit guilds might control the spread of medical lore, the Chinese physician kept his secrets to himself—passing them on only to sons or, sometimes, specially selected qualifiers.In early times, a physician gave his services out of philanthropy, for since the original healers were rulers, sages, nobles, and, perhaps, priests, economic and social incentives were absent. Later, direct fees or salaries were instituted, and the court and certain prosperous households kept physicians on retainer. Formal schools may have existed as early as the tenth century, and in the eleventh century an organization for medical education was set up under imperial auspices. Under the Ming dynasty in the fourteenth century, the school system became fixed. It changed little over the next centuries, xcept for a gradual decline, and by 1800 there was only one medical school left in Peking. Teachers were held strictly accountable for the performance of their students, and fines were imposed if the professor failed to enforce attendance or if his pupils did poorly on exams. The examination system was complex: a pyramidal structure provided a process of elimination which continued until those with the highest scores emerged. The top students could be heart doctors, the next level were assistant examiners, and lower scores could mean limited assignment in teaching.Specialization may have occurred early. While physicians and apothecaries were separate for a long time, they were both regarded as healers. In the Chou dynasty there were nine specialties, and they grew to thirteen by the Mongol period, early in the fourteenth century. The subdivisions became even more complex, with doctors for the great blood vessels, small vessels, fevers, smallpox, eyes, skin, bones, larynx, and mouth and teeth. There were also gynecologists, pediatricians, and pulsologists for internal diseases, external medicine, the nose and throat, and for children's illnesses.Some healers specialized in moxibustion, acupuncture, or massage. Even the experts in incantation and dietetics were considered medical specialists and were often held in higher regard than other doctor s; surgeons were generally of low rank. Furthermore, each of the practitioners in each category had assistants and students—all of whom had to qualify by examination. Obstetrics was in the hands of midwives for many centuries; it is not known when the first women doctors were in practice. One female physician is mentioned by name in documents from the Han dynasty (206 B.C. -A. D. 220), but women may have been doctors at an earlier date. By the fourteenth century women were officially recognized as physicians. Throughout the Ming dynasty (1368-1644), the practicing medical theorists could be divided into six main philosophic schools. The Yin-yang group focused on insufficiencies of one of these forces. The Wen-pou doctors attributed illnesses to a preponderance of yang and frequently prescribed ginseng and aconite. The Radical group used drastic medication.The Conservatives relied entirely on the authorities of the past, reedited the classic works, and made no deviations from strict authoritarianism. The Eclectic physicians, as their name implies, used a variety of principles from the other sects. The sixth school based all therapy on bringing the five elements and six vapors into harmony. Spread of Chinese Medicine to Korea, Japan, And Tibet Ancient Chinese medicine was well-developed long before the beginning of the Christian era, and its influence appears to have spread into adjacent Korea by the sixth century A.D. At that time, after a severe epidemic had ravaged Japan, Korean doctors who were invited to counsel Japanese physicians introduced them to Chinese medical classics and commentaries. By the seventh century, Japanese scholars and doctors were going directly to China for their information and experience. In the eighth century, a Chinese Buddhist monk named Chien Chen came to Japan and achieved a prominent position in the imperial court at Nara, where, given the Japanese name Kanjin, he taught, practiced medicine, and translated Chinese materia medica.Late in that century, Chinese medicine was well-established in Japan, and a medical school based on its methodology was founded by the Japanese physician Wake Hiroya. Early in the next century (806–10), the Emperor Heijo vainly attempted to combat foreign influence and restore traditional Japanese medical practice, but the methods of Chinese healing were too firmly entrenched. In the tenth century, acupuncture reached Japan, followed by moxibusti on (the word moxa is Japanese), and the full complement of Chinese medicine was accepted in Japan.With medical training closely based on Chinese systems, the Japanese exacted exceptionally intensive and prolonged study before permitting entrance into the profession by governmental examination. As in ancient China, high social standing was a requirement for admission to medical school, but separate instruction by assigned teachers was apparently also arranged to accommodate the more lowly. The authority of Chinese medicine, no t to mention Chinese culture and philosophy, moved east as well as west by the seventh and eighth centuries.However, Arabic and Indian missionaries of Islam and Buddhism made influence a two-way exchange as they traveled to China seeking converts. Since their missions necessitated the translation of Sanskrit and Arabic writings into Chinese and vice versa, medical knowledge inevitably was passed back and forth. Consequently, the crossroads areas of Southeast Asia and Tibet developed a medical system combining aspects of Chinese, Indian, and Arabic practice. Arabic influence, which stemmed in part from Greek teachings, was evident in the doctrine of four humors (phlegm, blood, bile, and wind), whereas Indian deas were seen in the Yogic placement of the soul in the core of the spinal column and reliance on breathing exercises. Traveling Buddhist priests, who were quite successful in spreading their faith, for a long time also practiced medicine. During this early period, the two wives (one Chinese) of a Tibetan king converted him to Buddhism, and thereafter scholars were invited to bring Chinese writings into Tibet, which resulted in collections in Tibetan called Kanjur and Tanjur, the latter containing medical information.In the thirteenth century, the Mongol conqueror Kublai Khan wanted this body of knowledge available again in Chinese but was unable to carry through the translation. Nevertheless, his grandson in the next century arranged for scholars from Tibet, Mongolia, and Central Asia to accomplish the task. Ironically, while the Mongols were in control they allied themselves with non-Chinese such as Uighars, Jews, Christians, and Moslems, and they preferred Arabic medicine to Chinese. Essay of Ancient China Ancient China In ancient Chinese cosmology, the universe was created not by divinities but self-generated from the interplay of nature's basic duality: the active, light, dry, warm, positive, masculine yang and the passive, dark, cold, moist, negative yin. All things, animate and inanimate, and all circumstances were a combination of these fundamentals. The ultimate principle of the universe was the tao, â€Å"the way,† and it determined the proper proportions of yin and yang in everything. Anything that altered the natural relation of yin to yang was considered bad, and right living consisted of carefully following the tao.If one observed the tao by moderation, equanimity, and morality, as taught in the Tao-te Ching, by Lao-tzu (sixth century B. C. ), one would be impervious to disease and resistant to the ravages of aging; disregard of the tao led to illness, which was not so much a punishment for sin as the inevitable result of acting contrary to natural laws. However, illn ess also could be caused by forces beyond one's control: â€Å"Wind is the cause of a hundred diseases,† and atmospheric conditions could upset the harmonious inner balance of the yang and yin.One had to be alert to this possibility and combat its effects as well as modify internal imbalances of the vital forces. Longevity and health were the rewards. Chinese medicine, in league with Taoism, was focused on the prevention of illness; for, as the legendary Huang Ti, father of Chinese medicine, observed, â€Å"the superior physician helps before the early budding of disease. † Although Taoist hygiene called for temperance and simplicity in most things, sexual mores were governed by the yin-yang aspect of Chinese philosophy.Ejaculation in intercourse led to diminution of a man's yang, which, of course, upset the inner balance of his nature. On the other hand, one was strengthened by absorption of the yin released by the orgasm of one's female partner—unless she was over thirty, the point where female essence lost its efficacy. The tao was important in Confucianism also, as the path of virtuous conduct, and for centuries the precepts of Confucius (K'ung Fu-tzu, 550-479 B. C. ) set the most prevalent standards of behavior. In early Chinese philosophy, there was a tendency to accept and combine aspects of all religions and to make way for new ideas.Nevertheless, the ancient Chinese were profoundly conservative once an institution, custom, philosophy, mode of dress, or even a furniture style was firmly established, and it remained relatively unchanged over centuries. As Confucius said: â€Å"Gather in the same places where our fathers before us have gathered; perform the same ceremonies which they before us have performed; play the same music which they before us have played; pay respect to those whom they honored; love those who were dear to them. † Although ancient China's development was relatively isolated, there was early contact with India and Tibet.Buddhism came to China from India, and medical concepts and practices were an important part of its teachings. The gymnastic and breathing exercises in Chinese medical methodology also came from India and were closely related to the principles of Yoga and to aspects of Ayurvedic medicine. There were also contacts with Southeast Asia, Persia, and the Arabic world. In the second century B. C. , the Chinese ambassador Chang Chien spent more than a decade in Mesopotamia, Syria, and Egypt, bringing back information on drugs, viticulture, and other subjects.Over the centuries, knowledge of humoral medicine and of numerous new medicaments filtered into China. The introduction of the wisdom of the Mediterranean world was greatly facilitated in the fifth century by the expulsion and wide dispersion from Constantinople of the heretical Nestorian Christians. The mother of Kublai Khan (1216-94), founder of the Mongol dynasty, was a Nestorian and asked the Pope to send European d octors to China. Early Medical Writings Classical Chinese medicine was based primarily on works ascribed to three legendary emperors. The most ancient was Fu Hsi (c. 2900 B. C. , who was said to have originated the pa kua, a symbol composed of yang lines and yin lines combined in eight (pa) separate trigrams (kua) which could represent all yin-yang conditions. This system is followed even today in the I Ching (Book of Changes), though as a game or superstition in the West. Shen Nung, the Red Emperor (Hung Ti), compiled the first medical herbal, the Pen-tsao (c. 2800 B. C. ), in which he reported the effects of 365 drugs, all of them personally tested. One legend explains that a magic drug made his abdominal skin transparent, so he could observe the action of the many plants he evaluated.Another story tells that he cut open his abdomen and stitched in a window. Shen Nung is also said to have drawn up the first charts on acupuncture, a medical procedure presumably even older than the legendary emperors. The fame of Yu Hsiung (c. 2600 B. C. ), the Yellow Emperor (Huang Ti), rests on his great medical compendium, the Nei Ching (Canon of Medicine). Transmitted orally for many centuries, this seminal work was possibly committed to writing by the third century B. C. Its present form dates from the eighth century A. D. when the last extensive revision was done by Wang Ping. The major portion of the Nei Ching, the Sun-Wen (Simple Questions), records the discourse of the Yellow Emperor with Ch'i Po, his prime minister, on virtually all phases of health and illness, including prevention and treatment. The section called Ling-Hsu (Spiritual Nucleus), deals entirely with acupuncture. Yu Hsiung also was said to be responsible for another great compendium, The Discourses of the Yellow Emperor and the Plain Girl, which thoroughly covered the subject of sex from the Taoist point of view.Among other notable sources for ancient medical lore, one might mention the Shih Ching (Boo k of Odes), which perhaps predates Homer's epics, and the Lun-yu, discourses of Confucius probably written down shortly after his death, which affected patterns of behavior for many generations. During the long Chou dynasty (c. 1050-255 B. C. ), a lengthy compilation of medical works, Institutions of Chou, was completed and became the criterion for subsequent dynasties on the duties and organization of physicians. In the Han dynasty (206 B. C. -A. D. 20), there was a noted clinical author named Tsang Kung, who pioneered in the description of many diseases, including cancer of the stomach, aneurysm, and rheumatism. Chang Chung-ching, the Chinese Hippocrates, in the third century A. D. , wrote the classic treatise Typhoid and Other Fevers. Ko Hung, a famed alchemist and a careful observer, wrote treatises describing beriberi (a vitamin B deficiency), hepatitis, and plague, and gave one of the earliest reports on smallpox: â€Å"As the New Year approached there was a seasonal affectio n in which pustules appeared on the face and spread rapidly all over the body.They looked like burns covered with white starch and reformed as soon as they were broken. The majority died if not treated. After recovery purplish black scars remained. † Sun Szu-miao (A. D. 581-682) wrote Ch'ien Chin Yao Fang (A Thousand Golden Remedies), which summarized in thirty volumes much of the known medical learning, and he headed a committee which produced a fifty-volume collection on pathology. An extensive codification of forensic medicine, Hsi Yuan Lu, was done in the Sung dynasty and became the prime source for knowledge of medical jurisprudence.Anatomy and Physiology Ideas of anatomy in ancient China were reached by reasoning and. by assumption rather than dissection or direct observation. Since the doctrines of Confucius forbade violation of the body, it was not until the eighteenth century, long after Vesalius, that the Chinese began systematic, direct anatomical studies. Even as l ate as the nineteenth century, in the Viceroy's Hospital Medical School, anatomy was taught by diagrams and artificial models rather than dissection.Physiological functions were constructed into a humoral system much like Greek concepts of the sixth century B. C. and Galenic views of the second century A. D. , except that there were five instead of four essential humors. (The number five had mystical value for the Chinese and was used for most classifications: five elements, five tastes, five qualities, five kinds of drugs, five treatments, five solid organs, five seasons, five emotions, five colors, etc. ) The medical compendium Nei Ching stated that each emotion had its seat in a particular organ.Happiness dwelt in the heart, thought in the spleen, sorrow in the lungs, and the liver housed anger as well as the soul. Ideas in the Nei Ching concerning movement of the blood (â€Å"All the blood is under control of the heart. † â€Å"The blood current flows continuously in a c ircle and never stops. â€Å") have been thought to approach an understanding of its circulation antedating Harvey by thousands of years; however, some body vessels were believed to convey air, and there is little evidence that commentators perceived the blood-carrying vessels as a contained system. DiagnosisThe Chinese methods of diagnosis included questioning, feeling the pulse, observing the voice and body, and in some circumstances touching the affected parts. In almost all times and cultures physicians have used a similar approach, for all healers have sought to know as much as possible about a patient in order to understand his or her illness and advise treatment. However, in some respects ancient physicians saw each patient more completely as a reflection of his surroundings (indeed, the entire universe) than does the doctor of today. The Chinese doctor wanted to learn ow the patient had violated the tao, and to do this he took into account the patient's rank; changes in his or her social status, household, economic position, sense of well-being, or appetite; the weather; and the dreams of the patient and his or her family. Perhaps the most important diagnostic technique of the ancient Chinese was examination of the pulse. The physician felt the right wrist and then the left. He compared the beats with his own, noting precise time as well as day and season since each hour affected the nature of the pulsations.Each pulse had three distinct divisions, each associated with a specific organ, and each division had a separate quality, of which there were dozens of varieties. Moreover, each division or zone of the pulse had a superficial and deep projection. Thus literally hundreds of possible characteristics were obtainable. In one treatise, Muo-Ching, ten volumes were necessary to cover all the intricacies of the pulse. A patient had only to extend his or her arm through drawn bed curtains for the physician to determine the symptoms, diagnosis, prognosis, a nd proper treatment by intensive palpation of the pulse.Whenever possible the examiner also felt the skin of the ill person. However, it was considered bad form for a man to intimately examine a woman, so special ceramic, ivory, and wooden dolls were pointed to by the invalid to indicate where discomfort was felt. Treatment According to the Nei Ching, there were five methods of treatment: cure the spirit, nourish the body, give medications, treat the whole body, and use acupuncture and moxibustion. The physician had to put the patient back on the right path, the tao.Assuming that specific mental states caused changes in specific organs, the healer linked certain objectionable behavioral and constitutional factors with illness and attempted to have the patient rectify these. For instance, dissolute and licentious ideas led to diseases of the lungs, but acting out such thoughts brought on heart trouble. A doctor had to determine the cause of disharmony in the body and act accordingly. Exercises were developed to keep the body fit and to restore well-being. Hua T'o, the great surgeon, worked out an ingenious system of physical therapy by advising mimicry of the natural movements of animals.Massage—kneading, tapping, pinching, and chafing—was also a regular method of treatment, as were the application of plasters and evacuation of the intestinal tract by cathartics. In nourishing a patient's body, the physician resorted to complex combinations of foods according to their potential amounts of yang and yin. Foods also had to fit the seasons, and each of the five tastes had benefits for a particular element of the body: sour for the bones, pungent for the tendons, salty for the blood, bitter for respiration, and sweet for muscle.Medications The Chinese pharmacopoeia was always rich, from the time of the Pen-tsao, the first medical herbal, to the later dynasties when two thousand items and sixteen thousand prescriptions made up the armamentarium. Drugs w ere considered more likely to be good if they tasted bad. As one would expect, they were classified into five categories: herbs, trees, insects, stones, and grains. The therapeutic minerals and metals included compounds of mercury (calomel was employed for venereal diseases), arsenic, and magnetic stones.Animal-derived remedies, in addition to â€Å"dragon teeth† (powdered fossilized bones), included virtually anything obtainable from living creatures: whole parts, segments of organs, urine, dung. Two plant substances especially associated with China may be singled out. One is ephedra (ma huang), the â€Å"horsetail† plant described by the Red Emperor, which was used for thousands of years as a stimulant, as a remedy for respiratory -diseases, to induce fevers and perspiration, and to depress coughs.Ephedra entered the Greek pharmacopoeia and eventually was disseminated throughout most of the world. It only became a factor in Western medicine in the late nineteenth cen tury after Japanese investigators isolated and purified the active principle, ephedrine, and established its pharmacologic action. A second medicinal herb, always highly popular among the Chinese, is ginseng (â€Å"man-shaped root†). To the Chinese, preparations containing ginseng were almost miraculous in delaying old age, restoring sexual powers, stimulating the debilitated, and sedating the overwrought.In addition it improved diabetes and stabilized blood pressure. In recent years this root has been under scrutiny by Western pharmacologists attempting to evaluate its true benefits. Multitudes in Asia, and even some Westerners, are so convinced of its effectiveness that high-grade wild roots have brought fabulous prices (even reaching thousands of dollars apiece). Although many items in the Chinese materia medica have either faded into bscurity or been labeled fanciful, others subsequently have been found to possess sound pharmacologic bases: seaweed, which contains iodine, was used in treating enlargement of the thyroid; the willow plant, containing salicylic acid, was a remedy for rheumatism; the Siberian wort has antispasmodics for menstrual discomfort; and mulberry flowers contain rutin, a treatment for elevated blood pressure. Whether opium was used as a drug before quite late in Chinese history is still in dispute. Acupuncture and Moxibustion These modalities have been an integral part of Chinese medical therapy for thousands of years.The Yellow Emperor is said to have invented them, but they may well have existed long before his time. The aim of these treatments was to drain off excess yang or yin and thus establish a proper balance, but external energy also could be introduced into the body. In acupuncture the skin is pierced by long needles to varying prescribed depths. Needles are inserted into any of 365 points along the twelve meridians that traverse the body and transmit an active life force called ch'i. Each of these points is related to a particular organ.For instance, puncture of a certain spot on the ear lobe might be the proper way to treat an abdominal ailment. Virtually every illness, weakness, and symptom is thought to be amenable to correction by acupuncture. Acupuncture spread to Korea and Japan by the end of the tenth century A. D. , to Europe about the seventeenth century, and recent years have seen a wider interest in this Chinese medical practice in the West. Individual paramedical healers and even some medical practitioners have been swamped with requests for acupuncture, especially for problems apparently little benefited by conventional practices.The eventual acceptability of this practice in standard Western medicine remains to be seen. Moxibustion is as old as acupuncture, and the same meridians and points govern placement of the moxa. However, in this treatment a powdered plant substance, usually mugwort, is fashioned into a small mound on the patient's skin and burned, usually raising a blister. Dentistry The treatment of tooth disorders was confined mainly to applying or ingesting drugs—pomegranate, aconite, ginseng, garlic, rhubarb, and arsenic, as well as animal products such as dung and urine.The Nei Ching classified nine types of toothaches, which included some obviously due to infections and tooth decay. Like the Mesopotamians and Egyptians, the ancient Chinese believed that worms were often responsible for dental problems. Toothpicks and tooth whiteners were used, and loose teeth were stabilized with bamboo splints. Gold was sometimes used to cover teeth, but the purpose was decorative rather than protective. Surgery Although surgery was not one of the five methods of treatment listed in the Nei Ching, the knife was known and used.Hua T'o, one of the few names mentioned in connection with surgery, treated an arm wound of the famous general Kuan Yu by cutting his flesh and scraping the bone. Physicians knew how to deal with wounds, and at least two classics we re devoted entirely to their treatment. The proper attitude toward pain was to bear it without a sign of emotion, and much was made of the insouciance of the general treated by Hua T'o; he played chess while the surgeon operated. Nevertheless, apparently some kind of anesthesia was often used.Wine and drugs like hyoscyamus were probably mainstays, but the use of opium and Indian hemp is still in question. Eunuchs and Footbinding Another surgical procedure, though hardly therapeutic, was the frequent castration of certain males seeking advancement at court. Though originally a severe punishment, the total removal of penis and testicles came to be a pledge of absolute allegiance to the monarch, since it released the eunuch from conflict with Confucian admonitions of first loyalty to family and the obligation of siring a son for posterity.Footbinding is also of medical interest, for it caused the development of artificially clubbed feet. Over a period of one thousand years, every young girl of proper family willingly permitted herself to be crippled by her mother and aunts to achieve the tiny foot of ideal feminine beauty. Her toes were gradually folded under the sole, and by increasingly tight bandaging her heelbone and forefoot were brought closer together. Without Golden Lotuses, as the best-shaped bound feet were called, a girl was unmarriageable, nor was the life of a courtesan open to her, for tiny feet were a woman's most desirable feature.For a man, a bound-foot wife had profound sexual significance, but she was also a status symbol inasmuch as her helplessness indicated that he was wealthy enough to support a woman, or women, in idleness. There was also an advantage to him in her restricted mobility, for it kept her home and made illicit amorous adventures difficult. Although China's Manchu conquerors forbade the practice in the nineteenth century, it was not until the early twentieth that footbinding was completely abandoned. Diseases Some epidemic dise ases were understood well enough to allow the development of protective measures.In the eleventh century, inoculation against smallpox was effected by putting scabs from smallpox pustules into the nostrils, a method which may have come from India. Wearing the clothing of someone who had the disease was another means of prevention. The relationship of cowpox (as a protective) to smallpox may have been perceived, since ingesting powdered fleas from infected cows was also recommended to stave off smallpox. But other devastating pestilences were neither understood nor held in check. During the Han dynasty an epidemic of what appears to have been typhoid fever killed two-thirds of the population of one region.Precise descriptions of leprosy in the Nei Ching and later works attest to the diagnostic accuracy of the early Chinese healers, but their explanation of the disease's causes and their treatment follow preconceived notions of the time. â€Å"The wind and chills lodge in the blood v essels and cannot be got rid of. This is called li-feng. For the treatment prick the swollen parts with a sharp needle to let the foul air out. † Fourteenth-century writings referred to chaulmoogra oil, a pressing from seeds of an East Indian tree, as a specific for leprosy, and this oil remained the principal antileprous drug even in the West until recent decades.An illness that may have been tuberculosis was recognized as contagious: â€Å"Generally the disease gives rise to high fever, sweating, asthenia, unlocalized pains making all positions difficult and slowly bringing about consumption and death, after which the disease is transmitted to the relations until the whole family has been wiped out. † Venereal diseases, although not well differentiated, received a variety of therapies, including the use of metallic substances for internal medication.In the Secret Therapy for the Treatment of Venereal Disease, the seventeenth-century physician Chun Szi-sung reported us ing arsenic, which, until the development of penicillin, was the modern medication for venereal disease, in the form of Salvarsan and derivatives synthesized by Paul Ehrlich. There seem always to have been places in China where the sick poor could go for medical care. With the advance of Buddhism in the Han and T'ang dynasties, in-patient hospitals staffed by physician-priests became common.However, in the ninth century, when anti-Buddhists were in control, hospitals as well as 4,600 temples were destroyed or emptied. Nevertheless, by the twelfth century hospitals had again become so numerous that virtually every district had at least one tax-supported institution. The upper classes preferred to be treated and cared for in their homes, thus leaving public hospitals to the poor and lower classes. The Practitioners In the Institutions of Chou, compiled hundreds of years before Christ, the hierarchy of physicians in the kingdom was delineated.The five categories were: chief physician ( who collected drugs, examined other physicians, and assigned them); food physicians (who prescribed six kinds of food and drink); physicians for simple diseases (such as headaches, colds, minor wounds); ulcer physicians (who may have been the surgeons); and physicians for animals (evidently veterinarians). Physicians were also rated according to their results, and as early as the Chou and T'ang dynasties each doctor had to report both successes and failures—to control his movement up or down in the ranks.In the seventh century A. D. examinations were required for one to qualify as a physician, some four centuries earlier than the first licensing system in the West. Medical knowledge was thought of as a secret power that belonged to each practitioner. Whereas in other societies, both advanced and primitive, closely knit guilds might control the spread of medical lore, the Chinese physician kept his secrets to himself—passing them on only to sons or, sometimes, specially selected qualifiers.In early times, a physician gave his services out of philanthropy, for since the original healers were rulers, sages, nobles, and, perhaps, priests, economic and social incentives were absent. Later, direct fees or salaries were instituted, and the court and certain prosperous households kept physicians on retainer. Formal schools may have existed as early as the tenth century, and in the eleventh century an organization for medical education was set up under imperial auspices. Under the Ming dynasty in the fourteenth century, the school system became fixed. It changed little over the next centuries, xcept for a gradual decline, and by 1800 there was only one medical school left in Peking. Teachers were held strictly accountable for the performance of their students, and fines were imposed if the professor failed to enforce attendance or if his pupils did poorly on exams. The examination system was complex: a pyramidal structure provided a process of elimination which continued until those with the highest scores emerged. The top students could be heart doctors, the next level were assistant examiners, and lower scores could mean limited assignment in teaching.Specialization may have occurred early. While physicians and apothecaries were separate for a long time, they were both regarded as healers. In the Chou dynasty there were nine specialties, and they grew to thirteen by the Mongol period, early in the fourteenth century. The subdivisions became even more complex, with doctors for the great blood vessels, small vessels, fevers, smallpox, eyes, skin, bones, larynx, and mouth and teeth. There were also gynecologists, pediatricians, and pulsologists for internal diseases, external medicine, the nose and throat, and for children's illnesses.Some healers specialized in moxibustion, acupuncture, or massage. Even the experts in incantation and dietetics were considered medical specialists and were often held in higher regard than other doctor s; surgeons were generally of low rank. Furthermore, each of the practitioners in each category had assistants and students—all of whom had to qualify by examination. Obstetrics was in the hands of midwives for many centuries; it is not known when the first women doctors were in practice. One female physician is mentioned by name in documents from the Han dynasty (206 B.C. -A. D. 220), but women may have been doctors at an earlier date. By the fourteenth century women were officially recognized as physicians. Throughout the Ming dynasty (1368-1644), the practicing medical theorists could be divided into six main philosophic schools. The Yin-yang group focused on insufficiencies of one of these forces. The Wen-pou doctors attributed illnesses to a preponderance of yang and frequently prescribed ginseng and aconite. The Radical group used drastic medication.The Conservatives relied entirely on the authorities of the past, reedited the classic works, and made no deviations from strict authoritarianism. The Eclectic physicians, as their name implies, used a variety of principles from the other sects. The sixth school based all therapy on bringing the five elements and six vapors into harmony. Spread of Chinese Medicine to Korea, Japan, And Tibet Ancient Chinese medicine was well-developed long before the beginning of the Christian era, and its influence appears to have spread into adjacent Korea by the sixth century A.D. At that time, after a severe epidemic had ravaged Japan, Korean doctors who were invited to counsel Japanese physicians introduced them to Chinese medical classics and commentaries. By the seventh century, Japanese scholars and doctors were going directly to China for their information and experience. In the eighth century, a Chinese Buddhist monk named Chien Chen came to Japan and achieved a prominent position in the imperial court at Nara, where, given the Japanese name Kanjin, he taught, practiced medicine, and translated Chinese materia medica.Late in that century, Chinese medicine was well-established in Japan, and a medical school based on its methodology was founded by the Japanese physician Wake Hiroya. Early in the next century (806–10), the Emperor Heijo vainly attempted to combat foreign influence and restore traditional Japanese medical practice, but the methods of Chinese healing were too firmly entrenched. In the tenth century, acupuncture reached Japan, followed by moxibusti on (the word moxa is Japanese), and the full complement of Chinese medicine was accepted in Japan.With medical training closely based on Chinese systems, the Japanese exacted exceptionally intensive and prolonged study before permitting entrance into the profession by governmental examination. As in ancient China, high social standing was a requirement for admission to medical school, but separate instruction by assigned teachers was apparently also arranged to accommodate the more lowly. The authority of Chinese medicine, no t to mention Chinese culture and philosophy, moved east as well as west by the seventh and eighth centuries.However, Arabic and Indian missionaries of Islam and Buddhism made influence a two-way exchange as they traveled to China seeking converts. Since their missions necessitated the translation of Sanskrit and Arabic writings into Chinese and vice versa, medical knowledge inevitably was passed back and forth. Consequently, the crossroads areas of Southeast Asia and Tibet developed a medical system combining aspects of Chinese, Indian, and Arabic practice. Arabic influence, which stemmed in part from Greek teachings, was evident in the doctrine of four humors (phlegm, blood, bile, and wind), whereas Indian deas were seen in the Yogic placement of the soul in the core of the spinal column and reliance on breathing exercises. Traveling Buddhist priests, who were quite successful in spreading their faith, for a long time also practiced medicine. During this early period, the two wives (one Chinese) of a Tibetan king converted him to Buddhism, and thereafter scholars were invited to bring Chinese writings into Tibet, which resulted in collections in Tibetan called Kanjur and Tanjur, the latter containing medical information.In the thirteenth century, the Mongol conqueror Kublai Khan wanted this body of knowledge available again in Chinese but was unable to carry through the translation. Nevertheless, his grandson in the next century arranged for scholars from Tibet, Mongolia, and Central Asia to accomplish the task. Ironically, while the Mongols were in control they allied themselves with non-Chinese such as Uighars, Jews, Christians, and Moslems, and they preferred Arabic medicine to Chinese.